Physical Therapy Management: Understanding the Patient Healthcare System in the United States

Physical Therapy Management: Understanding the Patient Healthcare System in the United States

Nitin Chhoda discusses the current patient healthcare system in the United States.  He explains how the current system will change the status of physical therapy management, its transition to EMR, and its effect on patients’ security of information.

physical therapy managementPhysical therapy management healthcare reform has been a long time coming and President Obama’s initiatives represent a beginning with enormous possibilities.

At the core of healthcare reform is providing access to quality health care services to all in an affordable cost.

Health information technology for physical therapy management is essential in achieving that goal, but to realize its full potential, it’s important to understand the patient healthcare system in the U.S.

Healthcare costs and physical therapy management in the U.S. exceed those in many other countries, yet the quality of patient care can vary widely among providers and regions of the country.

President Obama has a goal of utilizing electronic medical records (EMR) by 2014, a move that can radically improve patient care across the board.

The Healthcare System

The healthcare system in the U.S. can be slow, ponderous and delay essential treatment due to a lack of patient records or availability of insurance. Coordination of care is one of the largest problems facing any healthcare provider and efficient physical therapy management depends on accurate records from all available sources.

Partial records and lost documents result in redundant testing and expensive procedures, when funds could be better utilized to treat patients.

Healthcare in the U.S. is a multi-tiered system administered by a variety of physical therapy management providers, facilities and reimbursement plans. It’s a reactive system that focuses on treating illness, ailments and conditions after they occur, rather than emphasizing ways to avoid problems before they happen.

Effective patient treatment and physical therapy management are built through ongoing relationships, but continuity of care is often broken when a client loses their insurance.

physical therapy management understandingThe EMR Technology

Information technology of physical therapy management, such as EMRs, provide physical therapists with a complete, integrated record for each patient that will significantly reduce costs on all levels by eliminating redundant tests, therapies and treatments.

The implementation of health care technology and effective physical therapy management are essential for better patient care and to meet the healthcare demands of a growing population.

Physical therapy clinics must remain profitable, but many patients seeking physical therapy management and services are those insured through Medicare, Medicaid and similar programs that dictate unrealistic reimbursement limits and caps.

Health information technology that includes electronic medical record systems allows therapists to offer an enhanced level of patient care and verify insurance coverage to expedite the treatment process.

Protection of Patients

The Patient Protection and Affordable Care Act was signed into law on March 23, 2010. The law provides for increased access to healthcare services to many who had none before. It further seeks to limit expenses for consumers and move to a system of electronic medical records that offers extensive advantages for physical therapy management services.

EMRs represent the first generation of electronic records to manage patient health care more efficiently and assist in meeting the government’s goals of expanded access and overall savings within the healthcare industry.

For physical therapists, health information technology provides greater profitability through electronic billing submissions. Therapists have access to complete patient records, eliminating the need for costly physical therapy management and redundant testing that can delay critical treatments, while facilitating change in the patient healthcare system.

EMR and EHR – The Difference

EMR and EHR – The Difference

EMR and EHR are two different terms that are often used interchangeably. Nitin Chhoda discusses the difference between EMR and EHR and why this is important for your practice.

EMR programsThere’s been a lot of confusion about the difference in an electronic medical record (EMR) and an electronic health record (EHR), with some using the terms interchangeable.

An electronic medal record is an integrated software system that allows therapists to interact with patients and submit billing claims online, and increase the productivity of the clinic.

An EHR is a collection of data that includes a client’s medical history, personal statistics, billing information and demographics.

The two are very different and many researchers and vendors are still struggling to define each, though both groups tend to agree that EMRs will revolutionize the way medical professionals conduct business, deliver patient care and boost the prosperity of a practice.

EMR is the New Technology

As the debate rages on, one fact remains. Therapists must implement an EMR by 2014 as per The Affordable Care Act. There are dozens of available EMRs, most of which were designed with hospitals, physicians and critical care facilities in mind. They’re generally expensive to purchase and require huge monthly fees.

The good news is that there are very affordable options available that are designed specifically for physical therapy practices. Clinicians should exercise due diligence when researching an EMR and not install the first system they explore, thinking any system is better than none.

The goals of The Affordable Care Act were many and lofty. Some facets of the act were designed to lower healthcare costs, enhance patient care and provide improved access to healthcare services. EMRs will definitely be a cost saver for insurance providers, but they also have distinct advantages for physical therapy practices.

EMR and EHR

With an EMR, therapists can access a patient’s EHR to discover what tests and procedures have been ordered, prescriptions being taken and how the client responded to treatment. There’s no need to rely on a client’s memory for crucial medical information.

It’s all there in the EHR and can be accessed via an EMR by multiple healthcare professionals. Therapists can begin treatment sooner, without the need for duplicating costly tests. Access to the information in an EHR saves time for both clients and therapists.

The documentation in an EMR is stored electronically and can be submitted online for quicker turnarounds on reimbursements.

Denials can be addressed in a fraction of the time offered by traditional paper methods and postal service, and there’s no need to wait days or weeks to obtain patient information.

EMR web basedAn EMR also offers a convenient means of communication between therapists and patients to send payment and appointment reminders, post test results, request prescription refills and verify insurance coverage.

Healthcare providers can consult and collaborate through the medium of an EMR for more effective patient care.

In contrast, an EHR is a document representing a collection of data rather than a software solution. EHRs provide a complete record of a patient’s illnesses, ailments, allergies, prescriptions and immunizations.

It offers in-depth information about the client’s health history that can be instantly updated and accessed by multiple healthcare providers through an EMR. Along with health information, it encompasses valuable demographic data that therapists can utilize to market their practice and track referrals.

Multiple Tools

The 21st century method of record keeping has arrived with EMRs and they offer therapists multiple tools to create better patient care outcomes, market their clinics, and save enormous amounts of time, effort and money. While many continue to use the terms EMR and EHR interchangeably, therapists need to understand the difference for the good of their business.

EMR Solution: Monitoring and Improving Staff Productivity

EMR Solution: Monitoring and Improving Staff Productivity

Did you know that electronic medical records can not only make the documentation process faster but they can also help to monitor staff productivity?

Critical business metrics (time in / time out, number of patients seen, number of units billed) can give the practice owner important insight on how to improve the business more and increase profitability.EMRAn efficient practice is a productive practice, and one that’s able to treat more patients, expand and prosper. The key to that dream clinic is an EMR or electronic medical records system.

The system has a number of functionalities to help clinicians monitor the productivity of every staff member, identify problem areas or processes, and improve productivity throughout the clinic.

To maintain a steady cash flow within the clinic, practice owners must ensure that each staff member is seeing as many patients as possible each day, but without sacrificing the quality of care provided to each client.

Electronic Medical Record

An EMR can include date and time stamps, or a handwritten copy of the attending therapist or staff member, allowing practice owners to monitor how many patients each staff member is seeing and how much time they’re investing in each.

It’s imperative that practice owners implement an EMR specifically developed for a physical therapy clinic. It will contain the crucial elements needed by the practice and offer customization options that reflect the way the clinic is operated.

Following the implementation of an EMR, it’s normal for productivity to decrease as staff members become familiar with the new system. Speed and efficiency will increase the more they use the system.

The Greatest Challenges

Loss of productivity is one of the greatest challenges facing clinic owners. The problem may be staff members who are stealing time from the practice with extended breaks or lackluster performance, or the problem could lay within the office processes.

An EMR will provide the information needed for practitioners to pinpoint problem areas and take steps to effect improvement. Staffing requirements change as practices grow and an EMR provides clinicians with the information needed for the strategic allocation of employees.

Practice owners strive to maintain a full patient schedule, but some clients may require more involved treatments that are time intensive or there may be an increased need for specific services at certain times of the day.

All of those types of statistics are readily available with an EMR, allowing practitioners to schedule staff for optimum effect or terminate redundant employees. Improving on staff productivity isn’t confined to therapists within the clinic.

An EMR provides the tools to monitor and improve upon billing, coding and reimbursements, along with scheduling and communicating with patients.

Practitioners who have implemented an EMR can coordinate efforts with other healthcare providers to eliminate information gaps or duplication of tests that delays treatment.EMR solutionEMR Must Be Fully Understand

Many therapists fear the loss of productivity that immediately follows the implementation of an EMR without fully understanding the benefits to be had once employees are trained in the system.

An EMR offers metrics to identify the most productive employees and areas within the practice where processes and workflow can be improved.

Identifying problem staff and more efficient ways to operate the practice results in significant savings and greater revenues for therapists who want their clinics to grow, prosper and thrive.

EMRs increase profits, efficiency, documentation and staff productivity throughout the practice. An integrated EMR represents a major change for any clinic and provides practitioners with the tools needed to streamline their business, monitor and improve staff productivity, control employee costs and increase revenues within the 21st century practice.

In Touch EMR Eliminates Scanning and Uploading of Patient Documents

In Touch EMR Eliminates Scanning and Uploading of Patient Documents

With the technology of an iPad and the In Touch EMR, there’s no reason to scan and upload documents to a patient’s record ever again. At this time, the In Touch EMR has the only dedicated iPad app for physical therapy.

In Touch EMRIn Touch EMR stores information securely in the cloud and can be retrieved at any time. Implemented on the iPad, the EMR offers a fast, easy and simple system with almost unlimited uses.

Say Cheese

With the iPad’s built-in camera, patients can take a photo of themselves for identification purposes, right in the office.

The photo automatically goes where it needs to be with the integrated In Touch EMR and it’s permanently stored in the cloud.

Patients can also complete forms and photograph them for inclusion in their records.

It’s essential to verify each patient’s identity for reimbursements, prevent fraud and avoid identify theft.

A photo of the patient’s insurance card can be taken and added to their file for quick verification of coverage and services, thereby increasing front desk efficiency.

Photographic Documentation

Clinicians can take photos of individuals during the patient encounter to document their posture, injuries and other visible data. The photos are instantly attached to the patient’s record to create a visual profile and establish medical necessity.

Clinicians can snap a quick photo of referrals, documents and records from other providers, all of which becomes part of the patient’s record almost instantly.

Education

Clinicians need to understand the various elements of Obamacare so they can provide explanations to patients.

The In Touch EMR is an important tool for patient education.

Clinicians can use the In Touch EMR and iPad as a visual aid to help clients understand what they’re being told verbally. Instructions, examples and pertinent information can be called up, printed and given to patients to peruse at home.

Automating The Workflow

In Touch EMR and the iPad automates the before, during and after patient experience.In Touch EMR

Staff members spend less effort on time-consuming tasks and patients receive more quality time with their clinician. Billing can be completed and submitted, even before patients leave the office.

The combination of the In Touch EMR and an iPad eliminates the need for scanning, photocopying and uploading information to patient files.

The EMR in In Touch EMR stores data quickly, safely and securely in the cloud where it can be retrieved any time it’s needed.

Office processes are greatly improved for better efficiency, and clinicians have the ability to create a photographic profile of their patients, allowing them to bill quickly and reduce turnaround times on reimbursements.

 

Understanding the RAC Audit Process

Understanding the RAC Audit Process

One of the greatest challenges facing practitioners is a potential investigation by a Medicare Recovery Audit Contractor (RAC). Medicare estimates that there is a sixty two percent error rate among reimbursement claims in which documentation doesn’t match the billed expenses.

Private practice marketing expert, Nitin Chhoda, says that when services, fees and documentation don’t match, it increases the possibility of a RAC audit. The good news is that there are concrete steps clinicians can take to reduce the risk. And he shares that information in this article.

RACEven with the best coders and billers, errors can occur and it’s ultimately the responsibility of the practitioner to ensure that records match.

Knowing how the RAC process works allows clinicians to develop measures and install appropriate software systems to minimize risk factors that lead to an audit.

Medicare RAC auditors examine reimbursement claims after payment has been made, using methods similar to those employed by commercial healthcare insurance carriers.

The practice is known as pay and chase among industry officials. They look for inconsistencies in the billable services and submitted documentation.

RAC auditors utilize methods that comply with the Centers for Medicare and Medicaid Services (CMS) rules and regulations.

Determining the Two types of Audits

There are two types of audits – automatic and complex.

  • An automatic audit seeks easily identifiable errors in payments, but doesn’t require human intervention or medical records to determine a problem exists.
  • A complex audit addresses improper payments through a manual evaluation and a request for extensive supporting documentation. Medical providers have strict and definite timelines in which to request an extension, comply with producing the appropriate records, and make appeals.

The process doesn’t stop there. Practitioners singled out for a RAC will be reported to CMS for potential fraud. If the RAC determines the problem is a potential quality issue, they report the provider to the state’s Quality Improvement Organization.

Initiate Self-Audits in order to Minimize RAC Interventions

Conducting self-audits will help minimize RAC interventions, but the best way clinicians have of avoiding an audit is to ensure their flow sheet, plan of care and billed expenses all match. If they don’t, it’s a problem and the responsibility of the practitioner.

Integrated electronic medical record (EMR) software is a critical element and provides the first line of defense toward that goal of avoiding an audit.

RAC auditorsEach EMR differs slightly, but systems such as the In Touch EMR, and In Touch Biller Pro, have capabilities specifically designed to assist coders and billers.

When data is entered, it prompts and advises the user for information and data to ensure all the components match and support each other.

It’s a crucial feature that offers a greater level of compliance and minimizes the probability of an audit.

Knowing how and why a RAC audit is conducted provides clinicians with the necessary information to help them avoid the experience. Confirming that the flow sheet, plan of treatment and documentation are all in agreement is the first step. The second is implementation of an “intelligent” integrated EMR physical therapy software system.

An audit isn’t desirable, but instead of living in dread practitioners should look upon a RAC audit as an additional way to maintain compliance.

Reimbursement Claims: How Can to Make Sure I Get It the First Time Around?

Reimbursement Claims: How Can to Make Sure I Get It the First Time Around?

Clean reimbursement claims are the bread and butter of the medical billing industry. They pass the scrubbing process at clearinghouses quickly and generate revenues faster. Billers can take a variety of precautions to avoid denied claims and in this telling article, Nitin Chhoda reveals the most common billing mistakes.

reimbursement claims The first rule of medical billing is never assume anything. If a medical insurance biller (MIB) has any doubt due to a practitioner’s illegible scrawls, the type of treatment received or procedure performed, it’s imperative to contact the clinician for clarification.

Coding Errors

Mistakes and oversights in coding represent the number one reason that reimbursement claims are denied. Electronic medical record (EMR) technology can identify potential claim problems and notify the user. Insurance carriers are constantly seeking ways to avoid paying reimbursement claims and examine coding closely for the following items:

  • Mismatched coding that creates inconsistencies in the claims. A good example is gender specific ailments.
  • Truncated coding doesn’t address all three levels of the practitioner’s diagnosis is suspect.
  • Up and down coding is a red flag for carriers. Trying to obtain higher reimbursement claims or coding at a lower level in an effort to avoid denials can result in penalties, or the carrier may decide not to do business with the clinician.

Document Everything

Clean claims provide the appropriate documentation for every item, from the patient’s identity to the treatment provided. MIBs must ensure that reimbursement claims contain complete and accurate information on all facets of the patient’s visit.

When claims are returned with a request for supporting data, insurance carriers can become suspicious and suspect the medical provider or the MIB of altering or recreating documents to support a claim.

Billing Blunders

Unbundling is the act of billing separately for elements that should have been claimed as a whole. Insurance carriers allow for unbundling under very specific circumstances, but MIBs should utilize caution when doing so. Coding is designed to cover an entire treatment or procedure and will single out a claim for closer inspection.

Complying with Carriers

There’s no standard procedure when dealing with insurance carriers. Each company establishes its own rules for reimbursement claims submissions. MIBs who don’t adhere to the carrier’s specifications will be deemed non-compliant and the reimbursement claims will be denied. That can also encompass failure to obtain a pre-approval prior to the patient’s treatment.

Clerical Oversightsreimbursement claims process

Correct coding and detailed documentation won’t avoid a denial if the reimbursement claims contain omissions, data entered in the wrong location or typographical errors.

Even simple items, such as misaligned paper in a printer, can pose sufficient reason for a clearinghouse to reject a claim.

Most mistakes can be identified and corrected prior to transmission to the clearinghouse. It takes only moments to double check a claim before it’s sent, but correcting and resubmitting reimbursement claims can take hours of work and severely disrupts the flow of revenue. Knowing where the most common errors occur is the first step toward filing clean claims.